So How Long Are You Going to Work for a Living?

Dr BobbleheadSo my wife told me about another Vanguard Boglehead discussion, this one about a radiology resident trying to decide whether to go into private practice or academics. Some of the issues were more broadly applicable to the rest of medicine, including psychiatry. The original question and the advice you can see here.

First of all, nowhere (at least so far) do you see any mention of Maintenance of Certification (MOC) as an issue, which might suggest everyone just accepts it as a fact of life or part of the cost of doing business. However, a radiologist who sits on my state medical society’s board of directors contacted me not long ago asking for a little advice on how to make the case to support the principle of lifelong while opposing MOC at an upcoming meeting of the American College of Radiology at its upcoming national House of Delegates meeting in Washington, D.C.

I’m not sure what to make of that glaring omission, along with other major challenges facing doctors today. Although one of the bogleheads makes light of the physician shortage, at least one writer thinks it’s a pretty big deal.

I ask residents whether they want to work in academics or private practice and their answers vary. Many of them are not yet sure where they want to practice. In my opinion, the bogleheads in this instance mostly get it right about the differences.

MD assistant professors have two full time jobs: one job is 40+ hours of research, and the other is 40+ hours of clinical work. These academic MDs generally do not spend much time teaching, and spend little time with family (especially pre-tenure). So if you like teaching and spending time with family, and do not love love and love research, then a tenure-track academic position is not for you.

On the other hand, I’m not so sure I’m ready to accept another opinion, which is that “The government and Academia are immune to the laws of economic reality (for now).” Relative Value Units (RVUs) are a part of the compensation plan in our department although the psychiatry consultation service doesn’t make a lot of RVUs so I may not fit into the calculation. Granted, none of us are covering our salaries by any means and the research faculty are talking about hiring psychiatric hospitalists (wait a minute, aren’t I sort of a psychiatric hospitalist?) and using the Academic RVU, to which the following article abstract is relevant (and it’s even pertinent to the boglehead radiologists!):

Mezrich, R. and P. G. Nagy “The Academic RVU: A System for Measuring Academic Productivity.” Journal of the American College of Radiology 4(7): 471-478.
Despite the importance of teaching, research, and related activities to the mission of academic medical departments, no useful and widely agreed-on metrics exist with which to assess the value of individual faculty members? contributions in these areas. Taking the concept of the clinical relative value unit (RVU) as a model, the authors describe the development of an academic RVU (aRVU) system that assigns weights to and creates formulas for assessing productivity in publications, teaching, administrative and community service, and research. The resulting aRVU schema was implemented on a Web-based system that incorporates a number of novel tools, including a curriculum vitae manager that automatically maintains and calculates total aRVU scores and breaks out component elements for each individual and for the department as a whole. The benefits and limitations of this system are discussed, as well as the potential advantages in sharing this approach with other radiology departments and other medical disciplines. Wide acceptance and implementation would make the aRVU the appropriate counterpoint to the clinical work RVU in academic medicine.

If you need a reminder about RVUs and need a refresher about how much some people hate the Affordable Care Act, you can read the article referred to by one of the bogleheads.

Private practice for radiologists may be kind of a drag, according to one boglehead,

I have been in private practice radiology for 7 years. It is hard work and a grind. Little intellectual stimulation. Stressful especially when you are on call by yourself covering the hospital, emergency room, stat outpatients and often have too much on your plate at once. All about pleasing referrers and administrators. Benefit is the income but this is going down and we are working harder. I also like the amount of time off I have which is more than academics typically get. There is less job stability in private practice with many groups in the current climate being replaced, consolidated, employed by hospital etc.

Hey, this guy’s been out there a while. He may not be burned out, but you can sort of see it on the horizon. I have been in private practice very, very briefly and the boglehead is hitting the nail on the head. I wasn’t bored but I could see that running 20 patients a day through my clinic was not in my future. I’m too slow.

And I admit there’s some truth to what yet another boglehead said about academics.

In general, academic institutions can’t pay nearly as much as private b/c of structural issues: academic hospitals see poor and underserved patients no one else will see–profitable departments need to support other money losing departments/research initiatives.

Okay, so here’s my thing: I came back to academics twice because I sorely missed one thing about it–teaching. I get a monster kick out of it. It’s the one factor that makes me and my wife both doubt that retirement will be easy for me.

But I will retire… bet on it. Because for now I’m putting up with MOC and other indignities and hoops because I need to work for a living. But one boglehead got it wrong about academics not being able to save a lot for retirement.

We’ve been doing it. I’m not working for a living for the rest of my life.